CommercialAdministrativeHigh impact
[Georgia] Access surveys for primary care practitioners, specialty care practitioners, and behavioral health practitioners
Anthem BCBS·GA · Family Medicine, General Practice, Internal Medicine +3 more·Specialty Services
Effective date
Aug 1, 2026
We identified it
Aug 3, 2026
Summary
Anthem Georgia has implemented new access standards and monitoring requirements for primary care, specialty care (OB/GYN and oncology), and behavioral health practitioners, effective August 1, 2026. The policy establishes specific appointment timeframes (e.g., preventive care within 60 days, urgent care within 24 hours) and requires 24/7 after-hours coverage. Practices will be monitored via surveys, member grievances, and satisfaction analysis, with compliance documentation required for any failures to meet standards.
Action Required
By August 1, 2026: All participating practices must ensure compliance with access standards. (1) Front desk/scheduling staff: Update appointment scheduling protocols to meet timeframes—preventive care (60 days), routine check-ups (14 days for PCP, 30 days for SCP, 10 business days for BHP initial), and urgent care (24 hours for PCP/SCP, 6 hours for BHP crisis). (2) Clinical staff: Implement 24/7 after-hours coverage with live voice or recorded message (not voicemail-only) directing members to urgent care, on-call physicians, or callback options. (3) Providers: Update telehealth information on Availity by July 1, 2028 (sooner recommended) to display telehealth offerings in provider directory. (4) Practice leadership: Establish documentation process to record reasons if access standards are regularly not met. (5) Billing/administrative: Prepare for Anthem vendor surveys, member grievance analysis, and satisfaction assessments. Failure to meet these standards may result in corrective action plans, contract enforcement, or member complaints affecting practice reputation and reimbursement.